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In order to respond to the call of the National Health Commission to implement day surgery, this study elaborated the work process and the efficiency improvement strategies of hip and knee joint replacement in ambulatory surgery centre in foreign countries. It summarized the good points in process, summarized the management experience, combined with domestic conditions. It explored the key steps and matters needing attention related to the ambulatory surgery center of hip and knee joint replacement to provide reference for operating efficiency and speeding up the process of Enhanced Rehabilitation After Surgery in orthopedic field.
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Objective@#To observe the effect of home visit on joint function and complications of patients undergoing hip replacement.@*Methods@#Ninety cases of patients with artificial hip replacement who were admitted to our hospital from January to December 2017 were randomly divided into two groups by random Number Table Method.45 patients in the control group were given routine nursing after discharge, and 45 patients in the observation group were treated with home visit nursing. The hip function and living ability of the two groups were evaluated 8, 12, 16 weeks after discharge,and the complication rate was compared.@*Results@#The self-care ability scores of the observation group at 8, 12 and 16 weeks after discharge were 102.23±11.20, 108.36±10.41, 116.25±10.36 higher than those of the control group at 97.86±10.35), 100.21±14.26, 104.23±15.6, with significant differences (t=1.922, 3.097, 4.294, P < 0.05 or 0.01). The Harris scores of the observation group at 8, 12 and 16 weeks after discharge were 82.31±11.27, 87.38±10.05, 95.10±11.23 higher than those of the control group at 78.02±10.23, 83.41±11.74, 89.43±11.62, with significant differences (t=1.891, 1.723, 2.343, P < 0.05). The incidence of complications in the observation group at 16 weeks after discharge was 0 lower than 13.33% (6/45) in the control group (χ2=6.429, P=0.011).@*Conclusions@#Home visit intervention can improve the self-nursing ability of the patients after hip joint operation, promote the recovery of hip function and life ability, and reduce the complications.
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Objective To observe the effect of home visit on joint function and complications of patients undergoing hip replacement. Methods Ninety cases of patients with artificial hip replacement who were admitted to our hospital from January to December 2017 were randomly divided into two groups by random Number Table Method.45 patients in the control group were given routine nursing after discharge, and 45 patients in the observation group were treated with home visit nursing. The hip function and living ability of the two groups were evaluated 8, 12, 16 weeks after discharge,and the complication rate was compared. Results The self-care ability scores of the observation group at 8, 12 and 16 weeks after discharge were 102.23±11.20, 108.36±10.41, 116.25±10.36 higher than those of the control group at 97.86±10.35), 100.21±14.26, 104.23±15.6, with significant differences (t=1.922, 3.097, 4.294, P<0.05 or 0.01). The Harris scores of the observation group at 8, 12 and 16 weeks after discharge were 82.31± 11.27, 87.38±10.05, 95.10±11.23 higher than those of the control group at 78.02±10.23, 83.41±11.74, 89.43 ± 11.62, with significant differences (t=1.891, 1.723, 2.343, P < 0.05). The incidence of complications in the observation group at 16 weeks after discharge was 0 lower than 13.33% (6/45) in the control group ( χ2=6.429, P=0.011). Conclusions Home visit intervention can improve the self-nursing ability of the patients after hip joint operation, promote the recovery of hip function and life ability, and reduce the complications.
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Objective To explore the effect of trans-theoretical-model-based home visiting on hip function in community patients after hip joint replacement. Methods We chose 65 patients after hip joint replacement from January 2015 to March 2016 in our hospital:32 patients on odd days were set as the control group, where routine home visiting was done and the other 33 on even days as the experimental group, where community visiting based on trans-theoretical model. The two groups were compared in terms of Harris hip score at discharge and 6 months after discharge. Result The Harris hip score in the intervention group was significantly higher than that in the control group 6 months after discharge (P<0.05) and the hip function of the intervention group was better than that of the control group. Conclusions Community home visiting based on theoretical model can improve the hip function of patients after hip joint replacement compared with conventional health education models. This intervention method is worthy of popularization and application in community health education.
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Objective To discuss nicardipin′s influence on post operation cognitive dysfunction (POCD) in senior patient after hip joint replacement operation.Methods 180 senior patient, who received selective unilateral hip joint replacement operation between October 2015 and October 2016 under the condition of combined spinal-epidural anesthesia (CSEA) were randomly divided into Group A (with nicardipine) and Group B (without nicardipine).Nicardipine was only appropriately pumped into vein in time in Group A.MAP was observed and recorded 30 minutes after starting the operation and at the end of the operation.Mini-mental state examination (MMSE) was applied to score the patient one day before, one day, three days and five days after operation, and the number of POCD was recorded.Results Compared with Group B, Group A was obviously lower in MAP level (P<0.05) after 30 minutes.MMSE score of Group A was obviously higher (P<0.01) one day after operation.The number of POCD in Group A was 8 (8.89%) significantly lower than than that of Group B (19, 21.11%).Conclusion Nicardipine could maintain hemodynamic stability of senior patients receiving selective unilateral hip joint replacement operation under the CSEA and prevent POCD to a certain extent.
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OBJECTIVE:To investigate the effects of puerarin on bone mineral density around the femoral prosthesis of el-derly women after osteoporotic fracture artificial hip joint replacement. METHODS:99 elderly women after osteoporotic fracture artificial hip joint replacement were divided into control group(49 cases)and test group(50 cases)according to random number table. Control group received conventional treatment:calcium carbonate and vitamin D3+alendronate sodium+salmon calcitonin;test group was additionally given Puerarin injection 200-400 mg dissolved in Glucose injection 500 ml intravenously,qd,on the basis of control group. A treatment course lasted for 20 d,and both groups received 2 courses of treatment. The hip joint function score and bone mineral density around the femoral prosthesis of 2 groups were observed and compared after surgery,and the oc-currence of ADR was also observed. RESULTS:3 and 2 patients withdrew from control group and test group,respectively. 18 months after surgery,the patients with hip joint function score ranged 70-79 in test group was significantly less than in control group;the rate of excellent hip joint function score in test group was significantly higher than in control group,with statistical significance (P0.05);bone mineral density in R6-R7 range was signifi-cantly higher than control group(89.58% vs. 69.57%),with statistical significance(P<0.05). The prosthesis loosening was not found in both groups,and ADR was also not found as fever,erythra,nausea,vomiting,headache,dizziness,etc. CONCLU-SIONS:For the use of puerarin in elderly women after osteoporotic fracture artificial hip joint replacement,puerarin can increase the periprosthetic femur bone mineral density with good safety.
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PURPOSE: To assess the frequencies and sites of surgical glove perforations in lower extremity fracture surgery and hip joint replacement (HJR) surgery. Additionally, we also studied the usefulness of an indicator system glove. MATERIALS AND METHODS: We assessed surgical glove perforations in 30 cases of lower extremity fracture surgery and 18 cases of HJR surgery conducted by one right handed 1st operator from April 2013 to July 2013. We assessed frequencies and sites of perforation in 152 gloves; 95 used in lower extremity fracture surgery and 57 used in HJR surgery. We studied the perforation rates and sites according to participants and operation types. Using the Biogel indicator system glove, which is well known as a fast indicator of glove perforation, we were also able to assess the time difference between operative participant detection of perforation and inspector nurse detection while observing in the operative field. RESULTS: There were 18 of 30 cases in lower extremity fracture surgeries and 12 of 18 cases in HJR surgeries which had more than one surgical glove perforation event. Of all 152 gloves used, perforation occurred in 15 of 57 gloves (26.3%) in HJR surgery and 23 of 95 gloves (24.2%) in lower extremity fracture surgery. Perforation occurred more frequently in operators than assistant doctors or scrub nurses. The most frequent perforation site was the second digit of the left hand. On average, the time difference between operative participant notice of perforation and inspector nurse notice of perforation was 20.6 seconds. CONCLUSION: The perforation of surgical gloves happened in approximately one out of every four persons. Importantly, we noted a 37.0% prevalence of glove perforation in 1st operators. Considering that glove perforation is a critical factor responsible for intra-operative infection, surgeons must be conscious of the risk of surgical glove perforation and use double gloving regularly. Furthermore, indicator double gloving is recommended for fast detection of outer glove perforation.
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Humans , Gloves, Surgical , Hand , Hip Joint , Lower Extremity , PrevalenceABSTRACT
Objective To observe the therapeutic effect of Tianwang Buxin Decoction for delirium after hip joint replacement in senile femoral neck fracture patients. Methods A total of 57 senile patients with femoral neck fracture induced by falling were enrolled from the department of arthropathy of Zhongshan Hospital of Traditional Chinese Medicine admitted from September of 2009 to February of 2014. The patents were aged over 65 years, and had delirium after hip joint replacement. Random number method was used to divide the patients into Chinese medicine group ( 29 cases) and western medicine group ( 28 cases) , which were given oral use of Tianwang Buxin Decoction and Olanzapine separetely. Before and after treatment, we observed the scores of Delirium Rating Scale (DRS), time for delirium disappearing, and incidence of indifferent mind and somnolence.Results (1) After treatment, DRS scores were obviously decreased in both groups (P0.05). (2) The difference of time for delirium disappearing was insignificant between the two groups after treatment ( P>0.05). ( 3) After treatment, 7 cases of the control group had indifferent mind or somnolence, accounting for 25%. No case of the treatment group had indifferent mind or somnolence. The difference between the two groups was significant ( P<0.01). Conclusion Oral use of Tianwang Buxin Decoction has the same effect as Olanzapine for the treatment of delirium after hip joint replacement in falling-induced senile femoral neck fracture patients, and has the advantages of having no adverse reaction of indifferent mind or somnolence, and can realize comprehensive treatment by modification of the recipe according to the symptoms.
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Objective:To study the application value of postoperative comprehensive rehabilitation training in elderly patients with femoral neck fracture received hip joint replacement. Methods:elderly patients with femoral neck fractures who received hip joint replacement were enrolled and randomly divided into observation group given postoperative comprehensive rehabilitation training and control group given conventional intervention. Then knee joint function, hip joint function and quality of life were observed. Results:Harris score, HSS score and physical function, psychological function, social function, cognitive function, life quality score of observation group is higher than those of control group. Conclusion:comprehensive rehabilitation training has positive clinical value for it can improve the hip joint and knee joint function, enhance the quality of life.
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Objective To investigate the edge contact behavior of conformal spherical hip joint replacements under the given dynamic contact displacement condition. Methods Based on the developed spherical-grid-data model, the contact behavior and corresponding edge contact behavior of a typical metal-on-metal hip joint replacement was simulated under the increasing displacement between the acetabular cup and femoral head. Results It was found from the obtained results that the vertical and horizontal component of the support force due to contact pressure increased with the dynamic contact displacement increasing. The vertical component of support force for the edge contact showed a slower variation tendency than that for the non edge contact, while the corresponding horizontal component of support force increased more significantly with the dynamic displacement. In addition, the corresponding contact pressure distributions and the contact areas of hip joint replacements for edge contact and non-edge contact were different. Conclusions The significant edge contact behavior of hip joint replacements with bigger cup inclination angle occurrs with the increasing displacement of femoral head to the acetabular cup, which will cause the sliding between contact surfaces and additional wear since the horizontal support force increases. This provides a reference for the wear assessment and manufacturing of hip joint replacements.
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Objective Due to the limitation of manufacturing techniques, possible design optimization selecting and influence of its wearing in clinical application, the bearing surface of hip joint replacements is presented as non-spherical geometry, and the finite element method can be used to study the contact mechanics behavior in such kind of non-spherical hip joint replacement. MethodsThe reconstructing of non-spherical articular surface based on spherical-grid-data model (SGDM) was developed to investigate the effect of contact mechanics of an ellipsoidal head against a spherical cup in a typical metal-on-metal hip joint replacement. Results The maximum contact pressure of the non-spherical bearing was decreased effectively, and meanwhile the contact area was increased when curvature radius of the ellipsoidal head around the centre of the contact zone was increased, while the effects of the cup inclination angle on the maximum contact pressure and contact area of the non spherical bearing under the same load showed relatively small, but the contact pressure distributions were different. Conclusions A well-controlled non-sphericity can improve the magnitude and distribution of contact pressures on metal-on-metal hip joint replacements. In addition, the developed model and evaluation method in this paper can be used for simulation of dynamic contact and wear prediction of non-spherical hip joint replacements.
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Objective To study the contact mechanics of metal-on-metal hip joint replacements under different walking conditions, particularly for the edge contact behavior between the cup and the head of the bearing due to large range movement. Methods The finite element model of a typical hip joint replacement with conformal spherical bearing was established to simulate the edge contact of hip joint replacement under the given cup inclination angles and vertical loads. Results The maximum contact pressure decreased slightly and the contact area increased when the cup inclination angles increased within the range of 0°~60°. When the cup inclination angles were more than 80°, the corresponding contact area moved to the cup edge, the maximum contact pressure and distribution range increased, but the position of the maximum contact pressure moved from the initial contact point to the new point with 6°~9° in the direction of the increasing cup inclination angle to balance the corresponding contact pressure distribution and the loaded human weight. Conclusions Different edge contact behavior of hip joint replacements tends to occur due to the bigger cup inclination angle. Therefore, much attention should be paid to the problem of edge contact for both the clinical surgery and the manufacturing of hip joint replacements.
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[Objective] To analyze the clinical risk factors for the deep vein thrombosis(DVT)after the total hip arthoplasty(THA).[Methods]Fifty-one THA in 48 patients from February 2007 to July 2007 were evaluated.Color Doppler ultrasonography was used to detect DVT of bilateral lower extremities in all patients before operatioon and at 7 days after operation.Fifteen clinical factors were examined perioperatively in order to analyze their influences on DVT formation after surgery.[Results]Seventeen patients with DVT after operation were discovered through Color Doppler ultrasonic detection,and all of the DVT occurred at the calf intermuscular vein.The incidence of the DVT in all patients was 33.3%,and 41.7% of these DVT patients were asymptomatic.Logistic regression analysis indicated that patients older than 65(OR=116.597),large volume of blood transfusion(OR=1.01)and high level of triglycerides(OR=37.249)were the risk factors for the occurrence of DVT after the THA.[Conclusion]Female,old age,obesity,increase of the level of triglycerides and cholesteral,O blood type,large volume of blood transfusion and patients with diabetes or hypertension raised possibility the occurrence of DVT.Based on this research,it concludes that patients older than 65,large volume of blood transfusion and high level of triglycerides are the risk factors for the occurrence of DVT after the THA,doctors should control the total dose of blood transfusion,to reduce the dose per time and increase the times of massive blood transfusion.Besides these,both clinicians and doctors performing Color Doppler ultrasonography should pay attention to the calf intermuscular DVT.
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[Objective]To evaluate the preemptive analgesic effect and safety with celecoxib in patients undergone the hip joint replacement.[Method]Fifty patients scheduled for elective hip joint replacement were randomly divided into two groups,celecoxib group and control group.Those of celecoxib group were given celecoxib 200 mg 24,12 h before incision.The operation was performed under extradural anesthesia by the same surgeons. All patients were given celecoxib 200 mg 8,24,36,48,60,72 h after the operation.Before celecoxib administration and after the operation,pain intensity was measured using visual analog scale(VAS),and analgesic requirements,side effects,hip joint ranges of motion,sleep states,hemorheology and phlebothrombosises messured with the ultrasonic wave were compared.[Result]There were no marked differences in the VAS pain scores before celecoxib administration between two groups.Compared with control group,the patients of celecoxib group had significantly lower VAS pain scores after the operation(P
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@#ObjectiveTo evaluate the two common anesthesia techniques used in the hip joint replacement surgery (HJRS) and provide references to the most reasonable choice for them. MethodsTo undertake a retrospective study on 34 patients that received continuous epidural anesthesia(CEA) or combined intravenous and inhaled anesthesia(CIIA)respectively in HJRS. Results and Conclusions CEA had higher incidence of bone cement reaction than that of CIIA, whereas there was no significant difference in blood loss and the anesthesia efficacy between them. CIIA seemed to be easier to be performed. CIIA sounds more reasonable than CEA in HJRS although both of them are safe anesthesia techniques.
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Although the goal of fracture treatment is alive bony union with anatomical reduction, prosthetic replacement is indicated for some complicated femoral neck fracture. However it is not defined until now which one is selected between hemiarthroplasty and total hip replacement for the delayed or complicated femoral neck fracture. In order to get the criteria which one is better for this patient when indicated, we reviewed the result of 39 endoprosthetic and 16 total hip replacement patients at Seoul National University Hospital between June of 1975 to June of 1980. Both methods of endoprosthesis and total hip replacement showed satisfactory results of 72% and 90% respectively. Considering two points of the pain-relief and walking ability, total hip replacement is believed to be far better than endoprosthesis, especially for those patients who are over 50 years of age and have had more active living conditions before fracture.